At-Home Abortions Are a Class Issue

Last year, the government made home-use abortion pills available to all. It's now considering going back to clinic appointments – despite the time, money, and stress that at-home pills save.

One in three women will have an abortion before the age of 45. Despite that high number, attitudes towards this very normal procedure are often prudish and sometimes Victorian. At least one political premier is openly opposed to abortion, and others have shown support for limiting it. Under the Offences Against the Person Act 1861, abortion is still a criminal offence in the UK if not carried out under medical control.

Access to safe and legal abortion services should be a priority for most people, and this is no less, if not more, important during a pandemic, when staying at home as much as possible has become imperative. That’s why the government approved measures to allow patients within the first ten weeks of pregnancy to take abortion pills at home after a telephone call or e-consultation with a clinician, instead of having to go into a clinic. (In England and Wales in 2019, 82 percent of abortions were under 10 weeks.) Data shows that many patients took up the option, with more than half of all abortions by June taking place at home.

A consultation is now underway—until 26 February—to decide whether to make the measures permanent. ‘If there is a decision to stop it [tele-medical abortion care], it is not because of any scientific evidence,’ says Dr Jonathan Lord, a consultant obstetrician and gynaecologist at the Royal Cornwall Hospital, and Medical Director at MSI Reproductive Choices UK. ‘It will be wholly for political reasons.’

Abortion Rights Chair Kerry Abel echoes this sentiment. ‘We’re in a rare position now, for the first time in 56 years, where we’re actually talking about building on the legislation and making it better, rather than just defending sections of it.’

Abortion providers and charities have long argued that going into a clinic is unnecessary – not just for the patient, but for the NHS, too. Tele-medical abortion care has revolutionised abortion provision by giving patients greater agency and making the procedure easier; for the NHS, it cuts costs and saves time.

The option to take the pill at home has been particularly helpful for busy frontline workers. 23-year-old Chloe from Hampshire, who works in the NHS, was grateful not to have to organise time off work. ‘I’m so aware of the pressure we [the NHS] are all under,’ she tells Tribune.

Besides saving time, at-home pills mean patients can have the abortion when it’s most convenient for them. For Chloe, that meant receiving the pills on a Wednesday but waiting until Friday evening to take them. ‘Having the autonomy meant it was way less stressful,’ she says, adding that not having to walk through assessment rooms filled with maternity posters lessened the psychological impact, too.

Katherine O’Brien, Associate Director at the British Pregnancy Advisory Service (BPAS), acknowledges that it’s often ‘the circumstances surrounding the procedure, rather than the procedure itself’ that causes stress.

Ease of Access for All

In an age of zero-hour contracts, when missing one shift could mean losing out on all future work, the restricted access that forces people to go into a clinic to get abortions affects some more than others. As Abel says, ‘More than 50 percent of women who now have abortions already have at least one child, so you know that childcare is not an inconsequential factor. Travel is expensive, taking days off work is expensive, getting childcare is expensive.’

If you have a nanny, a work-from-home job (or a partner with a work-from-home job), a car, or a career in which you can pick your own hours, then getting to an abortion appointment is no problem. But for others, it’s a nightmare.

Barriers like these result in unequal access and place women at risk by delaying their medical treatment or forcing them to travel unnecessarily. In a 2017 study on abortion experiences, one woman said: ‘When I was on the bus I could feel that I was bleeding a lot. […] I was just kind of, y’know: ‘I’ve spent 45 minutes on a bus for a two-minute appointment.’’ As the at-home measures available this year have shown, this kind of experience is completely unnecessary.

‘While abortion is free at the point of use on the NHS, there are associated costs with attending medical appointments,’ O’Brien says. ‘People don’t recognise the financial barriers that exist even to just attending a medical appointment, but abortion is a class issue.’ BPAS once funded train tickets for appointments.

Keeping Patients Safe

In discussion of these issues, it’s important to remember that abortions are extremely safe, too: complications occur in less than one percent of procedures. But by delaying abortion care—with long waiting lists for appointments with an overstretched healthcare service—the risks of complications increase.

The average waiting time for abortion has halved since home use was allowed, and data from BPAS showed that major complications have dropped by two thirds. The risk of continuing pregnancy, which would require further treatment, is down by almost three quarters. The risks of abortion also decrease before eight weeks of gestation, and BPAS has said that in June 2020, 79 percent of abortions had occurred by this point – a 20 percent increase on the previous year. A study by the National Institute for Health and Care Excellence has shown for every day of waiting that can be shaved off, the NHS saves £1.6 million, owing to reduced complications and fewer needing to opt for a surgical abortion.

Tele-consultations and at-home pills are also important for people suffering domestic abuse situations, as patients may be given no choice but to turn to illegal methods like buying abortion medication online, risking up to life imprisonment under the current Victorian law. Pills by post have effectively curbed that trade.

A Loaded Decision

Some have, of course, expressed concerns – about the ability of patients to lie about gestation periods, for example. But O’Brien argues that the reticence to make abortion easier or more accessible is based on a misguided idea that if you make abortion accessible, ‘You incentivise women to not use contraception or not take contraception seriously, which is ridiculous and sexist.’

Chloe says she’s not calling for the government to abolish the face-to-face approach because, of course, complications do sometimes arise, and there’s a need for in-person appointments for higher-risk patients. But, for her, she couldn’t have felt more safe or efficient: ‘I’d be gutted if the government took this away,’ she says. The decision lies in Matt Hancock’s hands. We must hope that the man with power over millions of women’s bodies does the right thing.